RU2421247C2 - Method of injection therapy of pain syndrome in spine osteochondrosis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly to pain syndrome management in spine osteochondrosis. That is ensured by injections of 0.5% Novocaine containing hydrocortisone in painful points. The preparation is introduced in the amount of 0.1-0,2 ml and less in each point in the form of intramuscular, subcutaneous and periarticular injections. Total amount of the injected solution in one procedure makes 1 to 5 ml with the hydrocortisone content in a dose 2.5-5.0 mg.

EFFECT: with low traumatism and invasiveness, the method provides fast pain management, the absence of postinjection morbidity and symptoms of systemic effect of the drug due to considerable decrease of the amount of the introduced solution in each point and hydrocortisone dose.

3 tbl

Description

The invention relates to medicine, and specifically to injection methods for the treatment of pain.

Mesotherapy is a technique for treating or administering microdoses of special preparations, both homeopathic and allopathic, as well as their mixtures (cocktails) (Michel Pistor).

Mesotherapy is a technique of subcutaneous and intradermal microinjections of pharmacological preparations and vitamin complexes (Michel Pistor).

Mesotherapy is the treatment of certain pathological phenomena by affecting the connective tissue originating from the mesoderm leaf during embryogenesis, as well as affecting the pathology and local immunity of neighboring organs and tissues as a result of the high conductivity of the connective tissue (Dallos-Bourguignon).

Since 1950, the application of deeper local injections begins, performed in precisely defined anatomical structures, at the level of the stellate and lumbar sympathetic nerve, nerve roots and joints, and skin injection remains an additional method for providing transient local anesthesia.

In 1985, Janet G. Travel et David G. Simons proposed an injection therapy for muscle-fascial pain syndrome by intramuscular infiltration of novocaine (procaine) of the affected muscle, in which the so-called trigger points (TT) are located.

The increase in TT activity during its puncturing is apparently caused by mechanical stimulation of the ends of the sensory nerves that transmit TT activity. Injection of any liquid, saline or anesthetic causes leaching of sensitizing substances. Massage and pressor therapy increase blood flow in the TT and also help to wash these substances out of it (Janet G. Travel et David GJ Simons 1989).

Dry injection. Dr. Travell found that accurately piercing the TT with an injection needle without introducing any solution into it gives approximately the same therapeutic effect as injection of novocaine. However, this requires an accurate determination of the location of the TT.

Isotonic saline. Sola et Kuitert in 1955 conducted a course of treatment of myofascial TT in 100 patients with injections of saline containing a bacteriostatic agent. The therapeutic effect of this treatment was similar to that of local anesthetics.

The concentration of injectable novocaine. A study of the dependence of the effectiveness of novocaine on its concentration (from 0.1 to 2% in physiological saline) showed that its analgesic effect does not increase with increasing concentration after 0.5%. Since the maximum amount of novocaine that can be administered with a single injection is 1 gram, then, therefore, the volume of the injected solution will be 200 ml. We found that intramuscular injection of 40 ml of 0.5% novocaine for 30 minutes or more can cause only minor symptoms in the central nervous system. Accidental injection of 2 ml of a 0.5% solution of novocaine into an artery or vein is not accompanied by any complications if blood flow in the vessel is not stopped (Janet G. Travel et David G. Simons, 1989).

The choice of needle plays an important role for accurately entering the myofascial TT.

3.8 cm long needles No. 22 are usually used for superficial muscles. If the patient is sensitive to pain, then needle No. 25 (3.8 cm) can be used, but it does not allow you to clearly feel the pierced structure and it is much more difficult to mechanically destroy the TT.

For injections of massive skin muscles, such as the gluteus maximus muscle, in obese people need needle No. 21 (5 cm).

In deep muscles, such as the gluteus maximus and square lumbar, needle No. 21 (7.6 or 8.9 cm) is needed.

Myotoxicity of local anesthetics. When injecting long-acting local anesthetics, such as novocaine 0.5% or lidocage 1.0%, moderate muscle infiltration by lymphocytes and macrophages occurs in the next 24-48 hours, sometimes coagulation necrosis develops in the center of the muscle mass. In the neighboring muscle, there is intense eosinophilic infiltration with vacuolization, loss of transverse striation and some phagocytosis of muscle fibers (minimal necrosis). By day 7, the changes disappear. Repeated intramuscular injections also cause an inflammatory response (Pizzolato P., Mannheimer W. 1961).

Corticosteroids can prevent, but not eliminate, anaphylactic shock (Goodman L.S. Gilman A. 1970, Covino B.G., 1972). Thus, in the absence of contraindications, hydrocortisone acetate is preferably included in the composition of the administered cocktail for the prevention of possible complications.

The therapy according to the method developed by A.P. Tuzlukov, N.S. Gorbatovskaya, copyright certificate No. 1097333, is aimed at the pathology of the cervical spine. The method is as follows. Painful muscular-dystrophic formations in the occipital-collar zone are palpated. These formations are marked by a solution of iodine. 12.5-25 mg of hydrocortisone acetate is dissolved in 20-40 ml of a 0.5% solution of novocaine, after which a thin needle (No. 0425) is used to infiltrate painful muscle seals. In addition, the infiltration of novocaine and hydrocortisone is painful during palpation of the sites of the supraspinatus ligament in the cervical region, as well as the place of muscle attachment. For each injection, 1.0-1.5 ml of solution is consumed, for the entire procedure 20-40 ml of solution. Re-infiltration is carried out after 4-5 days. The course of treatment consists of 4-8 infiltrations. The applied small doses of hydrocortisone do not have a side effect on the body, providing a sufficient local concentration of the drug. With increased sensitivity to novocaine, hydrocortisone is administered in a mixture with physiological saline (Tuzlukov A.P., Gorbatovskaya N.S. 1985).

According to the above method of A.P. Tuzlukov and N.S. Gorbatovskaya, it is necessary to say the following: a sufficiently large amount of novocaine and hydrocortisone injected leads to fainting, and often to an increase in blood pressure after the procedure, ”which increases the number of contraindications.

Thus, we can assume that the introduction of large volumes of up to 200 ml as suggested by Travel and Simons, as well as significantly less than 1.0-1.5 ml at the injection point and throughout the procedure, 20-40 ml of the solution according to the method developed by A.P. .Tuzlukov, N.S. Gorbatovskaya, also cannot be physiological. After the procedure, post-injection pain occurs, which is associated with the inflammatory effect caused by local anesthetics due to the large dose of the drug administered. The introduction of doses of 0.1-0.2 ml is optimal for tissues, more physiological and does not cause negative consequences and increases the effectiveness of treatment.

G.A. Ivanichev 1990 suggests the use of reflexology (RT) of painful muscle seals. A widespread principle of selection of exposure sites in RT of all diseases is locally segmental. It consists in the use of points (dermatomic and myotomic); spinal points located along the vertebral and paravertebral lines of regional points located in the area of projection onto the skin of certain internal organs; local or local points intended for direct impact on underlying tissues (muscles, ligaments, joints). Reflexology sessions are held daily, every other day or once every few days. Exposure to RT methods should not be tiring for the patient. For a course of 10-12 sessions, a repeated course in 2-4 weeks - 3 months, depending on the effectiveness of the first course and the dynamics of the disease during the break.

Thus, based on the foregoing, the duration of the course of treatment is from 34 days to 3-4 months, which can not be called not tiring.

Ignasio Ordiz (1999) in the book Tratado de mesoterapia offers the following mesotherapy technique for pain syndromes in sports medicine and neurology: intradermal injection to a depth of 2-4 mm with a Lebel needle (27G) 4 mm long, 0.4 mm in diameter (caliber) , napazh less than 2 mm, injections according to the system "point by point" 4-10 mm, while the amount of drug administered is quite significant (0.1-0.5 ml), mesopuncture at the acupuncture point with the most suitable needle BD 30G1 / 2 ( 12 mm), mesoperphysia is performed by infusion with a more or less voluminous syringe 10 cc. using a Pistor-4 gun with a time interval of 8 to 48 seconds (set in the gun) during this pause, the drug is distributed into the skin tissue, which usually does not cause pain caused by rupture (weakening) of the tissue and mechanical stimulation of multimodal skin receptor enhances the analgesic effect. But it should be noted that most of the points are located in the muscle tissue and injections performed intradermally and subcutaneously do not reach the pain points located in the muscles, the effect of mesotherapy in this technique is sharply reduced.

In the training manual “Introduction to Mesotherapy” (2007), as well as O.S. Ozerskaya (2007) in the book “Technological Foundations of Mesotherapy” confirm the method of drug administration similarly to Ignasio Ordiz (1999).

Other data on the intramuscular injection method and

subcutaneous microinjections in the available literature is not found.

Table 1 Comparative characteristics of injection treatment methods (according to the main indicators) Methodology The amount of novocaine, which is part of the cocktail The number of hormonal drugs (if necessary) Dose per injection Type of injection Janet G. Travel et David G. Simons 6.5% to 200 ml (1 g) Oral corticosteroids from 1.0 to 200 ml intramuscular A.P. Tuzlukov H.S. Gorbatovskaya 0.5% from 20 to 40 ml (0.1-0.2 g) Hydrocortisone 12.5-25 mg 1.0-1.5 ml Intramuscular, periarticular Ignasio Ordiz 2% 2 ml (0.04 g) Diprospan 1 ml, Kenalog-40 1 ml 0.1-0.5 Intradermal, subcutaneous Proposed methodology 0.5% to 5 ml (0.025 g) Hydrocortisone 2.5-5 mg 0.1-0.2 ml Subcutaneous, intramuscular, periarticular

It should be noted that the proposed method provides not just chipping an organ or pain zone, but introducing it very precisely directly to the pain point in micro doses, which exclude the local toxic effect of drugs.

I used the method of chipping pain zones from 1990 to 2009. When, contrary to logical arguments, the more drugs were administered, the greater the effect, I tried to inject a solution in a dose of 0.1 ml, that is, ten times less than with the traditional technique. The first thing that attracted attention was the patient’s statement that his pain completely stopped right after the injection. The next day, a second visit is scheduled, on which, as a rule, a repeated procedure was performed for finding pain points in the same area and their chipping. Imagine my surprise when the patient said that there was no pain at all in the indicated place, and we moved to another zone.

In further work, I repeated the method of administering drugs with the same success in other patients, as a result, the treatment time was reduced by two to three times, the rather unpleasant post-injection pain syndrome disappeared and, accordingly, the rehabilitation time was reduced.

Carrying out procedures according to this technique leads to a programmed result of treatment with a good expected result. In 187 treated patients, a positive result was obtained in 93.3% of cases.

table 2 Comparative indicators of the proposed and traditional methods Number of treatments The amount of solution per course (ml) The amount of glucocorticoid per course (mg) The amount of solution per 1 procedure (ml) The amount of glucocorticoid per 1 procedure (mg) According to the proposed method 4.75 ± 2.7 19.42 ± 14.1 0.73 ± 0.5 3.70 ± 1.7 0.15 ± 0.05 According to the traditional method 10.3 ± 2.7 32.7 ± 12.3 175 ± 27.7 18.9 ± 7.7 19.1 ± 5.4

Based on the foregoing, it is proposed that the injection method of treatment be carried out directly at pain points located in the subcutaneous tissue, muscles, ligaments, as well as periarticularly. The procedure for injecting pain therapy according to the proposed method is based on the introduction of drugs (cocktails) in microdoses in an amount of not more than 0.1-0.2 ml per injection, which leads to the following results:

- the disappearance of pain immediately after the procedure;

- there is no post-injection pain;

- small volumes of injectable solutions up to 5 ml in most cases 2.0-3.0 ml, according to the traditional method from 20.0 to 200.0 ml;

- due to the small volume of the injected solution, there are no symptoms of a general effect (dizziness, fainting, lowering or increasing blood pressure);

- quick recovery of the function of the musculoskeletal system;

- the average number of procedures per course is 5.1 ± 1.7 procedures, the traditional method is 10.3 ± 3.7,

- compatibility with other treatment methods;

- short rehabilitation period;

- no repeated procedures per zone are required;

- technical simplicity;

- low invasiveness and invasiveness;

- pharmacoeconomics;

- throughput of 5-7 people per hour.

When testing the proposed treatment method, the authors obtained the following statistical results, which, after a year of work, changed slightly.

Table 3 The average number of procedures per treatment course and effectiveness (% improvement) Years Number of patients Average number of treatments per course Therapy efficacy 2007 350 11.5 ± 3.5 77.6% 2008 321 10.3 ± 3.7 75.5% 2009-2010 proposed technique 187 4.75 ± 2.7 93.3%

The proposed technique is highly effective, tested not theoretically, but on hundreds of patients in practical work. The technique is fully developed and ready for widespread use, ranging from the selection of patients and features during the procedure to the final stage at the end of the piece and preventive recommendations.

It is necessary to pay attention to the fact that the amount of glucocorticoid administered in one procedure was 2.5-5.0 mg, and with the traditional method 12.0-25.0 mg.

For one course of treatment, the dose of glucocorticoid is from 2.0 mg to 20.0 mg, and according to the traditional method from 125 mg to 250 mg.

And the number of procedures required to carry out the necessary effective course of treatment is 4.75 ± 2.7, and with the traditional method 10.3 ± 3.7.

Claims (2)

1. A method of treating pain with osteochondrosis of the spine by administering drugs to pain points, characterized in that a 0.5% solution of novocaine containing hydrocortisone is used as the drug, while the drug is administered in a volume of not more than 0.1-0.2 ml to each point in the form of intramuscular, subcutaneous and periarticular injections with a total volume of injectable solution per procedure from 1 to 5 ml and a content of hydrocortisone in a dose of 2.5-5.0 mg. 2. The method according to claim 1, characterized in that the procedures are carried out with an interval of 7-10 days.